Electrocardiogram interpretation in NCAA athletes: Comparison of the 'Seattle' and 'International' criteria.

BACKGROUND: Accurate electrocardiogram (ECG) interpretation in competitive athletes requires the distinction of physiological adaptations from findings suggestive of a pathological condition. The purpose of this study was to compare the performance of the Seattle Criteria to the International Criteria in a large dataset of NCAA athletes screened with an ECG. METHODS: ECGs from 5258 NCAA athletes who underwent prior ECG screening were re-examined by two experts in the field of sports cardiology and by ECG interpretation software by Cardea (© 2018 Cardiac Insight Inc.) using the Seattle and International Criteria. Each ECG was classified as normal or abnormal and the specific ECG abnormalities noted. Chi-squared analysis was used for statistical comparisons. RESULTS: The total number of ECGs flagged as abnormal by expert over-read decreased from 158 (3.0%) using the Seattle Criteria to 83 (1.6%) using the International Criteria (p<0.0001). Likewise, the total number of abnormal ECGs using ECG interpretation software by Cardea decreased from 278 (5.3%) using Seattle Criteria programming compared to 134 (2.5%) using International Criteria programming (p<0.0001). The most common ECG abnormality by expert over-read using the International Criteria was T wave inversion 40 (48%). The newer definition of pathological Q waves reduced the number of ECGs flagged as abnormal from pathologic Q waves from 69 (Seattle) to 11 (International) (84% reduction; p<0.0001). Expert over-read using both criteria and both Cardea interpretation programs identified all 13 athletes with cardiac pathology associated with sudden cardiac death. Cardea software using the International Criteria had a higher false-positive rate (2.3%) than expert over-read (1.3%) (p=0.0001). CONCLUSIONS: Use of the International Criteria for ECG interpretation significantly reduces the total abnormal and false-positive ECG rates compared to the Seattle Criteria without compromising sensitivity. Cardea interpretation software performs well and may be a useful tool to assist clinicians.

COPD in primary care settings in Ireland: stories from usual care.

The aim of the PRINCE study was to determine the effectiveness of a structured education pulmonary rehabilitation programme for those living with COPD in primary care in Ireland. This qualitative element of the larger PRINCE trial aims to describe the constituents of 'usual care' for patients allocated to the control arm of the study. A descriptive qualitative study was used to explore the constituents of usual care. A convenience sample of participants (n=20) allocated to the usual care group were interviewed. Three main themes arose from the study: experiences of having and managing COPD, lifestyle advice, and factors that helped or hindered self-management. Usual care left many people grappling in the dark trying to manage their COPD. It was found that usual care was not at its optimum for people with COPD in the control arm of the PRINCE study.